introduction to Infectioncontrol

Infection Control:

Infection Control An Introduction to By: Rosauro Ibabao Jr. BSN, RN, ICN Muhayl National Hospital Abha, Aseer Region, K.S.A.

Learning outcomes:

Learning outcomes Describe the sources of micro-organisms, routes of transmission and key principles of infection control List the essential elements of universal precautions Understand the importance of risk assessment and management in infection control

The pre-scientific era:

Epidemics and plagues throughout history Physicians fear of contagious disease Hippocrates and others suspected an unseen invisible cause Climate and environment blamed - not the ill, dying or dead The pre-scientific era

Microbiology - scientific era:

Microbiology - scientific era Anton van Leeuwenhoek (1632-1722) Dutch linen draper Amateur scientist Grinding lenses, magnifying glasses, hobby First to see bacteria “little beasties” No link between bacteria and disease

Scientific era continued . . . . .:

Scientific era continued . . . . . Ignaz Semmelweiss (1818-1865) Obstetrician, practised in Vienna Studied puerperal (childbed) fever Established that high maternal mortality was due to failure of doctors to wash hands after post-mortems Reduced maternal mortality by 90% Ignored and ridiculed by colleagues

Scientific era continued . . . . .:

Scientific era continued . . . . . Louis Pasteur (1822-1895) French professor of chemistry Studied how yeasts (fungi) ferment wine and beer Proved that heat destroys bacteria and fungi Proved that bacteria can cause infection - the “germ theory” of disease

Scientific era continued . . . . .:

Scientific era continued . . . . . Joseph Lister (1827-1912) Scottish surgeon Recognised importance of Pasteur’s work Concerned about infection of compound fractures and post-operative wounds Developed carbolic acid spray to disinfect instruments, patient’s skin, surgeon’s skin Largely ignored by medical colleagues

Scientific era continued:

Scientific era continued Robert Kock (1843-1910) German general practitioner Grew bacteria in culture medium Showed which bacteria caused particular diseases Classified most bacteria by 1900

The nature of infection:

The nature of infection Micro-organisms - bacteria, fungi, viruses, protozoa and worms Most are harmless [non-pathogenic] Pathogenic organisms can cause infection Infection exists when pathogenic organisms enter the body, reproduce and cause disease

Hospital acquired infection:

Hospital acquired infection Infection which was neither present nor incubating at the time of admission Includes infection which only becomes apparent after discharge from hospital but which was acquired during hospitalisation (Rcn, 1995) Also called nosocomial infection

Modes of spread:

Modes of spread Two sources of infection: Endogenous or self-infection - organisms which are harmless in one site can be pathogenic when transferred to another site e.g., E. coli Exogenous or cross-infection - organisms transmitted from another source e.g., nurse, doctor, other patient, environment (Peto, 1998)

Spread - entry and exit routes:

Spread - entry and exit routes Natural orifices - mouth, nose, ear, eye, urethra, vagina, rectum Artificial orifices - such as tracheostomy , ileostomy , colostomy Mucous membranes - which line most natural and artificial orifices Skin breaks - either as a result of accidental damage or deliberate inoculation/incision

Chain of infection:

Chain of infection Source/reservoir of micro-organisms infected person [host] or other source Method of transmission hands, instruments, clothing, coughing, sneezing, dust etc. Point of entry orifices, mucous membranes, skin Susceptible host low resistance to infection

HAI - common bacteria:

HAI - common bacteria Staphylococci - wound, respiratory and gastro-intestinal infections Discovered in Abeerden Scotland in 1880 by Sir Alexander Ogston in PUS from surgical abcess Golden cluster or the seed gold Frequently part of the skin flora found in the nose and on skin It can survive on domesticated animals such as dogs, cats and horses, It can survive for hours to days, weeks, or even months on dry environment surfaces.

Slide 15:

Infection can be spread through skin to skin contact, and also with objects such as towels, sheets, clothing, or athletic equipment. Range of illness Minor skin infections pimples, impetigo, boils, cellulitis folliculitis , carbuncles, abcess To life threatening diseases such as Pneumonia, meningitis, osteomyelitis, endocarditis, toxic shock syndrome, chest pain, bacteremia, and sepsis Treatment: * Penicillin * Duration of treatment depends on the site of infection and on severity

Slide 16:

Escherichia coli - wound and urinary tract infections Discovered by Theodor Escherich in 1885 Commonly found in the lower instestine of warm blooded organism Most E. Coli strains are harmless E. Coli normally colonize an infants gastrointestinal tract with in 40 hours of birth, arriving with food or water or with the individual handling the child

Slide 17:

E. Coli bacteria escape the intestinal tract through a perforation. Ulcer Ruptured appendix Or due to surgical error Transmission Fecal oral transmission Ex. Unhygienic food preparation, farm contamination due to manure fertilization, raw ground beef, raw seed sprout of spinach, raw milk, unpasteurized juice, unpasteurized cheese, contaminated food workers, flies

Slide 18:

Prevention Cook food clean and properly Preventing cross contamination Use of gloves for food workers Instituting health care policy Pasteurization Proper hand washing Treatment Antibiotics Ex. Amoxicillin, Cephalosporins , carbapenems , aztreonam , cprofloxacin , etc

Slide 19:

Streptococci (Strep Troat ) Normal commensal flora of the mouth, skin, intestines and upper respiratory tract of humans Strepto meaning easily bent or twisted Streptococus species are responsible for many cases of meningitis, bacterial pneumonia, endocarditis, erypsipelas and necrotizing fasciitis (flesh eating bacterial infections)

Slide 20:

However, many streptococcal species are non-pathogenic indeed, Streptococci are necessary ingredient in ( Emmentaler Swiss Cheese) Transmission Through direct contact with mucus from the nose or throat of persons who are infected or through contact with infected wounds or sores on the skin. Treating an infected person with an antibiotic for 24 hours or longer generally eliminates their ability to spread the bacteria. However, it is important to complete the entire course of antibiotics as prescribed.

Slide 21:

Salmonella (Food Poisoning) Salmonella develop diarrhea, fever, vomiting, and abdominal cramps 8 to 72 hours after infection. Illness lasts 4 to 7 days and most people recover without treatment. However, in some persons the diarrhea may be so severe that the patient becomes dangerously dehydrated and must be taken to a hospital. In severe cases, the Salmonella infection may spread from the intestines to the blood stream, and then to other body sites, and can cause death unless the person is treated promptly with antibiotics.

Slide 22:

Sources Poultry, pork, and cattle, if the meat is prepared incorrectly or is infected with the bacteria after preparation. Infected eggs, egg products, and milk when not prepared, handled, or refrigerated properly. Reptiles such as turtles, lizards, and snakes, which may carry the bacteria on their skin. Pet rodents. Tainted fruits and vegetables.

Slide 23:

Treatment The patient may receive intravenous fluids to treat the dehydration, and medications may be given to provide symptomatic relief, such as fever reduction Antibiotics

Slide 24:

Prevention The FDA has published guidelines to help reduce the chance of food-borne salmonellosis . Food must be cooked to 68–72°C (145–160°F) and liquids like soups or gravies must be boiled. Freezing kills some Salmonella , but it is not sufficient to reliably reduce Salmonella below infectious levels. While Salmonella is usually heat-sensitive, it does acquire heat resistance in high-fat environments such as peanut butter. Hand Washing

HAI:

HAI Hepatitis A - infectious hepatitis Hepatitis B - serum hepatitis Hepatitis C – Serum hepatitis Tuberculosis MRSA HIV

Universal infection control precautions:

Universal infection control precautions Devised in US in the 1980’s in response to growing threat from HIV and hepatitis B Not confined to HIV and hepatitis B Treat ALL patients as a potential bio-hazard Adopt universal routine safe infection control practices to protect patients, self and colleagues from infection

Universal precautions:

Universal precautions Hand washing Personal protective equipment [PPE] Preventing/managing sharps injuries Aseptic technique Isolation Staff health Linen handling and disposal Waste disposal Spillages of body fluids Environmental cleaning Risk management/assessment

Hand washing:

Hand washing Single most effective action to prevent HAI - resident/transient bacteria Correct method - ensuring all surfaces are cleaned - more important than agent used or length of time taken No recommended frequency - should be determined by intended/completed actions Research indicates: poor techniques - not all surfaces cleaned frequency diminishes with workload/distance poor compliance with guidelines/training

Hand washing – areas missed:

Hand washing – areas missed Taylor (1978) identified that 89% of the hand surface was missed and that the areas of the hands most often missed were the finger-tips, finger-webs, the palms and the thumbs.

Personal protective equipment:

Personal protective equipment PPE when contamination or splashing with blood or body fluids is anticipated Disposable gloves Plastic aprons Face masks Safety glasses, goggles, visors Head protection Foot protection

Sharps injuries:

Sharps injuries Prevention correct disposal in appropriate container no recapping, (scope method) discard needles and ampules strictly in sharp’s container only (separate the needles from the body) avoid over-filling of sharps container, (¾ only then dispose).

Aseptic technique:

Aseptic technique Sepsis - harmful infection by bacteria Asepsis - prevention of sepsis Minimise risk of introducing pathogenic micro-organisms into susceptible sites Prevent transfer of potential pathogens from contaminated site to other sites, patients or staff

Isolation:

Isolation Single room or group Source or protective Source - isolation of infected patient mainly to prevent airborne transmission via respiratory droplets pulmonary tuberculosis Protective - isolation of immuno suppressed patient Significant psychological effects

Staff health:

Staff health Risk of acquiring and transmitting infection Acquiring infection immunisation cover lesions with waterproof dressings restrict non-immune/pregnant staff Transmitting infection advice when suffering infection Report accidents/untoward incidents

Linen handling and disposal:

Linen handling and disposal Bedmaking and linen changing techniques Gloves and apron - handling contaminated linen Appropriate laundry bags Avoid contamination of clean linen Hazards of on-site ward-based laundering

Waste disposal:

Waste disposal Clinical waste - HIGH risk potentially/actually contaminated waste including body fluids and human tissue yellow plastic sack, tied prior to incineration Household waste - LOW risk paper towels, packaging, dead flowers, other waste which is not dangerously contaminated black plastic sack, tied prior to incineration

Spillage of body fluids:

Spillage of body fluids PPE - disposable gloves, apron Soak up with paper towels, kitchen roll Cover area with hypochlorite solution e.g., Milton, for several minutes Clean area with warm water and detergent, then dry Treat waste as clinical waste - yellow plastic sack

Environmental cleaning:

Environmental cleaning Recent concern regarding poor hygiene in hospital environments (NHSE, 1999) Some pathogens survive for long periods in dust, debris and dirt Poor hygiene standards - hazardous to patients and staff “Hospitals should do the sick no harm” (Nightingale, 1854)

Risk assessment:

Risk assessment No risk of contact/splashing with blood/body fluids - PPE not required Low or moderate risk of contact/splashing - wear gloves and plastic apron High risk of contact/splashing - wear gloves, plastic apron, gown, eye/face protection

Body fluids:

Body fluids Cerebrospinal fluid, peritoneal fluid, pleural fluid, synovial fluid, amniotic fluid, semen, vaginal secretions, Any other fluid containing visible blood e.g., urine, faeces

Cost of HAI:

Cost of HAI Direct cost to NHS for: extended hospital stay, extra resources, extra treatment, extra equipment, and extra community care costs if discharged needing follow-up Direct cost to patient/family for: pain and scarring, extended stay away from family, working days lost, family income loss, financial strain - increased visiting etc, increased morbidity, increased mortality

Core references:

Core references Davies, H. and Rees, J. (2000) Psychological effects of isolation nursing (1): mood disturbance. Nursing Standard . 14, 28, 35-38. May, D. (2000) Infection control. Nursing Standard . 14, 28. 51-57. ICNA (1998) Guidelines for hand hygiene . Belper: ICNA. NHS Executive (1995) Hospital laundry arrangements for used and infected linen - HSG (95) 18 . London: DoH. Nightingale, F. (1854) Notes on nursing . Edinburgh: Churchill Livingstone Peto, R. (1998) “Infection control”, In: Mallik, M., Hall, C. and Howard, D. (eds) Nursing knowledge and practice - a decision making approach . London: Bailliere Tindall. Rcn (1995) Infection control in hospitals . London: Rcn.

Internet sites:

Internet sites http://www.icna.co.uk/ http://www.nursing-standard.co.uk/ http://www.medscape.com/ http://www.anes.uab.edu/medhist.htm http://www.shef.ac.uk/~nhcon/ http://medweb.bham.ac.uk/nursing/ http://www.healthcentre.org.uk/hc/library/default.htm

The end:

The end